title: Piperacillin/tazobactam in the treatment of Klebsiella pneumoniae infections in neonates.
abstract: Nosocomial Klebsiella pneumoniae infection is associated with a high mortality in neonates and antimicrobial therapy of these infections has been complicated by the emergence of multiresistant strains. These organisms remain susceptible to only a few antimicrobial agents, and some of these are not recommended for use in children. In this study the antimicrobial agents used in the treatment of 33 neonates with Klebsiella pneumoniae (K. pneumonia) infection in our tertiary neonatal unit, during an outbreak were: piperacillin/tazobactam (13), imipenem/cilastatin (17), cefotaxime (2), and ciprofloxacin (1). Extended-spectrum beta-lactamase production was detected in K. pneumoniae isolates from 18 of 33 (54.5%) neonates. All-cause mortality was 13 of 33 (39.4%) and there was no significant difference in mortality between neonates treated with imipenem/cilastatin (6 of 17 or 35.3%) and neonates treated with piperacillin/tazobactam (6 of 13 or 46.2%). The duration of antimicrobial therapy and total hospital stay was similar between neonates who received imipenem/cilastatin and those that received piperacillin/tazobactam. This report suggests that piperacillin/tazobactam may be a useful antimicrobial agent in neonatal infections caused by beta-lactamase-producing organisms.
authors.affiliation: Department of Paediatrics, University of Natal, South Africa.
authors.forename: T
authors.initials: T
authors.lastname: Pillay
authors.forename: D G
authors.initials: DG
authors.lastname: Pillay
authors.forename: M
authors.initials: M
authors.lastname: Adhikari
authors.forename: A W
authors.initials: AW
authors.lastname: Sturm
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D015377:Cilastatin / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003428:Cross Infection; D004338:Drug Combinations; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology / Q000627:therapeutic use; D007231:Infant, Newborn; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use*; D010878:Piperacillin / Q000494:pharmacology / Q000627:therapeutic use*; D011480:Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D000078142:Tazobactam; D013845:Thienamycins / Q000494:pharmacology / Q000627:therapeutic use; D065093:beta-Lactamase Inhibitors
chemical_list: D000890:Anti-Infective Agents; D004338:Drug Combinations; D004791:Enzyme Inhibitors; D010406:Penicillins; D011480:Protease Inhibitors; D013845:Thienamycins; D065093:beta-Lactamase Inhibitors; D015377:Cilastatin; D002939:Ciprofloxacin; D015378:Imipenem; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin